Assessing Bolus Retention in Achalasia Using High-Resolution Manometry With Impedance: A Comparator Study With Timed Barium Esophagram

Abstract Background Intrabolus pressure (IBP) recorded by high-resolution manometry (HRM) portrays the compartmentalized force on a bolus during esophageal peristalsis. HRM may be a reliable screening tool for esophageal dysmotility in patients with elevated average maximum IBP (AM-IBP). Timed barium esophagram (TBE) is a validated measure of esophageal emptying disorders, such as esophagogastric junction outflow obstruction and achalasia. This study aimed to determine if an elevated AM-IBP correlates with esophageal dysmotility on HRM and/or delayed esophageal emptying on TBE. Methods A retrospective analysis of all HRM (unweighted sample n=155) performed at a tertiary referral center from 09/2015-03/2017 yielded a case group (n=114) with abnormal AM-IBP and a control group (n=41) with a normal AM-IBP (pressure<17mmHg) as consistent with Chicago Classification 3. All patients received a standardized TBE, with abnormalities classified as greater than 1 cm of retained residual liquid barium in the esophagus at 1 and 5 minutes or as tablet retention after 5 minutes. Results AM-IBP was significantly related to liquid barium retention (p=0.003) and tablet arrest on timed barium esophagram (p=0.011). A logistic regression model correctly predicted tablet arrest in 63% of cases. Tablet arrest on AM-IBP correlated with an optimal prediction point at 20.1 mmHg on HRM. Patients with elevated AM-IBP were more likely to have underlying esophageal dysmotility (95.6% vs. 70.7% respectively; p<0.001), particularly esophagogastric junction outflow obstruction disorders. Elevated AM-IBP was associated with incomplete liquid bolus transit on impedance analysis (p=0.002). Conclusions Our findings demonstrate that an elevated AM-IBP is associated with abnormal TBE findings of esophageal tablet retention and/or bolus stasis. An abnormal AM-IBP (greater than 20.1 mm Hg) was associated with a higher probability of retaining liquid bolus or barium tablet arrest on TBE and esophageal dysmotility on HRM. This finding supports the recent incorporation of IBP in Chicago Classification v4.0.

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Mo1877 Assessing Bolus Retention in Achalasia Using High Resolution Manometry With Impedance: A Comparator Study With Timed Barium Esophagram

Gastroenterology ◽

10.1016/s0016-5085(14)62467-7 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-678-S-679

Author(s):

Anna Lipowska ◽

Yu Kyung Cho ◽

Frédéric Nicodème ◽

Elyse R. Johnston ◽

Andrew J. Gawron ◽

...

Keyword(s):

High Resolution ◽

High Resolution Manometry ◽

Barium Esophagram

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Practical Approach to Refractory GERD GI Perspective over the Last 40 Years

Foregut: The Journal of the American Foregut Society ◽

10.1177/26345161211025478 ◽

2021 ◽

pp. 263451612110254

Author(s):

Joel E. Richter

Keyword(s):

Gastric Emptying ◽

High Resolution ◽

Proton Pump ◽

Acid Reflux ◽

Team Approach ◽

Upper Endoscopy ◽

High Resolution Manometry ◽

Refractory Gerd ◽

Barium Esophagram ◽

Complex Cases

Refractory GERD patients not responding to BID proton pump inhibitors are often referred for anti-reflux surgery. Over the last 40 years, I have learned the importance of a team approach with comprehensive esophageal testing to appropriately find the patients who will benefit from surgery. All patients need upper endoscopy, high-resolution manometry and prolonged pH testing. Selected patients may need a barium esophagram or gastric emptying testing. All complex cases are discussed at our weekly esophageal conference which includes gastroenterologists, foregut surgeons and swallowing therapists. Ten case scenarios are presented of recurrent themes in patients with “refractory” GERD, many whom don’t have acid reflux.

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